Tirade of a vindictive doctor

Doctors are supposed to offer support to families in times of medical crisis. Here’s one at MAHC who went out of her way to make like even more difficult at the worst possible time, even to the point of fabricating an incident to discredit the family.

Just seconds after informing us that our mother had been diagnosed with aspiration pneumonia and was unlikely to survive, she launched into a tirade of hostility and accusations within earshot of other patients, visitors and staff. She shouted “You have been very rude to the nursing staff and I personally do not like dealing with you. In the four years of working here I have never met a family like you. You are very difficult to deal with. I don’t even like to look after your mother because of you.”

She recorded this and other comments verbatim in a progress note and placed it in our mother’s chart. She then accused us of being “litigious people” and announced, “Everyone is already aware that you will be suing all of us.” This was another of her fictional inventions. We had never even hinted at any intention of suing the hospital or anyone connected with it. She had a history of creating entires in the chart that mocked concerns we had expressed to nursing staff about our mother.

Just the day before, and in response to the concerns we voiced about our mother’s deteriorating condition (which eventually led to aspiration pneumonia), the doctor wrote in a progress note, “They seem to be micromanging her care. Perhaps they are ready to take her home.” Less than 24 hours later, she would advise us that our mother was unlikely to survive.

A week earlier, this same doctor, whom we had encountered on only one occasion, had expressed objection over our fear that our mother’s anti-seizure medication had been abruptly stopped, contrary to well-documented pharmacological warnings. When we asked that it be gradually tapered instead, the doctor complained in a progress note, “Very difficult to please them, no matter what anyone does.” She would later admit, as we had asserted, that she made a prescribing error, as well, when she ordered the medication to be given by mouth when she knew her patient could not swallow and was at high risk of choking and aspiration. To some at MAHC, wanting things done safely and according to established safety practices was another example of our being “difficult” and “unreasonable,” as this doctor asserted.

This same doctor made repeated references in the chart to what she called our “poor treatment of nursing staff.” She often cited events that never occurred, blaming us for a nurse apparently quitting her job, for instance, and using preposterous phrases like “caused quite a stir last night.” No such concerns were ever expressed or noted by the nursing supervisory chain of command.

We later discovered after reviewing the chart that the doctor had fabricated an allegation that she had been “pushed…into the hallway” by a family member. She later admitted, after months of efforts by the family to have the defamatory record corrected, that the allegation that improper physical force was used on her was “incorrect” and that no force was ever used. It would be difficult to overstate the impact that this false and malicious accusation had, along with the myriad others, on the family, or our humiliation that it had been placed in the medical chart where other members of our mother’s care team and hospital officials would have seen it and likely drawn an extremely adverse inference from it.

The doctor has hired a major Toronto law firm. The hospital decided that this was the kind of doctor it wanted to showcase in its promotional video.

>Hundreds of other medication errors in prescribing, dispensing, transcribing, administering and monitoring, including drugs delivered by the wrong route, administration of wrong drugs, extra doses and omitted doses.

>Repeated errors by MAHC's pharmacy, including wrong-route instructions and major drug interactions that were ignored. Risks of serotonin syndrome, resulting from the combined administration of multiple serotonin agents, were never documented or disclosed to the family. The drugs diltiazem and buspirone should not be prescribed and administered together, according to experts. This warning was disregarded at MAHC, the interaction was never documented as a risk and never disclosed to the family.

>Inadequate attention to her condition, and disregard of strongly recommended evidence-based protocols, saw our mother become severely malnourished at MAHC, a condition that is especially life-threatening to the elderly and which predisposed her to known complications. Showing signs of significant weight loss on admission to MAHC, she was not even weighed until her fifth week there. Her malnourished state continued to worsen during her stay and was never disclosed to the family.

• A video consultation with a specialist in traumatic brain injuries was never arranged, despite the changing symptoms of her brain injuries and the availability of such technology at MAHC.

• When she was diagnosed with pneumonia, she was denied access to both the hospital’s ICU and its respiratory therapy services.

• Required pressure-reducing mattress surfaces and other cushioning devices, along with more intensive nursing care, were never provided after our mother was assessed at the highest possible risk for pressure ulcers or properly treated when skin breakdowns occurred. She was discharged the day after her chart clearly showed the appearance of a Stage II pressure ulcer. It was never properly documented and was concealed from the family as well.

• No doctor examined her for 24 hours after she suffered a major convulsive seizure within hours of showing a blood pressure reading of 197/76 mmHg that failed to prompt any action or special attention from physicians or nursing staff that morning. Hours later her blood pressure spiked to 233/117 mmHg.

• Hundreds of mandatory procedures to prevent complications were never conducted by nursing staff nor was their omission discovered by nursing supervisors. Many evidence based recommended tests to monitor the patient's condition were never performed.

• Long periods frequently lapsed between changes of incontinence of products, including one period of 24 hours between changes noted in the chart. Often, between 6 and 8 hours passed between chart-documented changes or care of any kind.

MAHC's CEO, board of directors and senior clinical leadership refuse to address the specific concerns presented to them, will not acknowledge any medication errors and insist that our mother "received appropriate care." They now speak only through their high-priced Toronto lawyers, who claim that our "allegations" malign the hospital and its staff and are defamatory.

Who Runs MAHC?

The photo of MAHC's board of directors previously appearing on this site has been removed under the threat of legal action by Muskoka Algonquin Healthcare, which alleged copyright infringement regarding the picture contained on its website.

Would you like your mother treated this way?

Danger signs of extremely high blood pressure were ignored with serious results. When a morning reading showed 197/76 mmHg, still no changes in care or special flagging from doctors or nurses occurred. The next read of blood pressure was to be taken two hours later. Nursing staff never bothered. Less than two hours after the missed reading, our mother suffered a major convulsive seizure lasting several minutes. That is considered the most severe type of seizure. Blood pressure at that time was charted at 233/117 mmHg. This was a critical incident for a brain injured elderly patient, yet no doctor showed up to examine herfor 24 hours, even in the face of repeated pleas from the family. Evidence-based guidelines and neurology experts in seizures recommend that blood chemistry be tested after a first seizure and that a CT scan be performed. No neurological tests or blood work were ever ordered after her seizure. There was no CT scan as the family had requested. There was no documentation in the chart about the type of seizure, its duration and the condition of the patient prior to it. When we talk about neglect and inattention to the high-risk nature of our mother’s condition, this is an example of what we mean. But for MAHC, it is an example of “appropriate care.”

Our mother was denied access to the hospital's ICU when she developed aspiration pneumonia, even though the family was told it would likely be fatal. "What's the point?" a doctor flippantly replied to the family's request, "She could die tonight anyway." Over the course of her care, hundreds of procedures necessary to assess and prevent the risk of aspiration were not performed, based on chart findings.

Pressure ulcers in hospitals are considered to be adverse events that are usually avoidable if proper care is taken. They are especially dangerous and painful for the bed-ridden elderly. For our mother, however, there was a complete failure to follow required standards of practice, and physician orders, to prevent skin breakdowns, even though she was assessed at high risk. As a result, she developed extremely painful Stage I and Stage II pressure ulcers (those terms were never used in the chart, however). The chart shows 54 days out of 79 when no required treatment was provided, even on days when the coccyx was described as being "++ red." Pressure-reducing mattress surfaces were never provided and repositioning in bed every two hours did not occur, even though both are required by standards of practice. Shortly before discharge home, her chart notes that she had developed a slit on her coccyx with an "open area." As part of the culture of cover-up encountered at MAHC, it failed to properly document the pressure ulcer and concealed it from the family. The extent of her injury was not discovered until her return home, resulting in significant additional costs for her care and commitment of family time.

From the onset of her brain injuries, our mother was unable to swallow safely. All medication and nutrition were delivered via an enteral tube. MAHC decided to reassess her swallowing abilities in a swallowing test performed on our mother at the same time she was receiving physiotherapy. She was placed on the edge of the bed, while obviously trembling from a fear of falling and clutching the bed rail with all her might. Her face grimaced in distress. Not surprisingly, she showed little interest in drinking water or eating the ice cream at the time. The team performing the test then immediately told the family her lack of interest indicated that she had lost her will to live. They discouraged us from having any hope. There was no follow-up to the family’s complaint about the incident.

Throughout her hospitalization, the chart shows that long periods often went by -- in one case some 24 hours, and frequently between 6 and 8 hours -- between checking or changing of incontinence products. Repositioning was not performed to the standard of care, which requires that a patient be turned every two hours when she is deemed to be at moderate or high risk of developing a pressure ulcer. When a complaint about our mother's condition was made to a nursing supervisor, she told us that if the patient were the mother of a prominent person or local politician, she would be receiving amuch better standard of care at MAHC

A large syringe containing medication was inserted with such force into our mother’s blocked enteral tube that the syringe exploded, spraying medication all over her eyes, mouth, face and hair, her clothes and the walls and ceiling of her room. No record of the incident appears in the chart, and there was no follow-up or apology, in spite of the matter being reported by the family to a nursing supervisor when it occurred.

There was frequent inattention to our mother's safety. A nurse placed a call bell beside her at a time when she was disoriented and had impaired cognitive function. When the nurse returned, more than 3 hours later, the chart shows our mother was found with the call bell cord wrapped around her and with her feet over the railing. Bed rails were often left down, even though our mother was noted in the chart as having attempted to climb out of bed on several occasions. Another nurse placed a supper tray in front of her and fed her soft food, despite the chart indicating both immediately before and after this event that our mother was designated NPO (nothing by mouth) because she could not swallow and was at high risk of aspiration.

When we raised concerns with a night-shift nurse who had left our mother’s prepared medications open and unattended in the hallway outside her room for more than an hour, she snarled, “You just want everything to be so perfect for your mother, don’t you?” Her tone dripped with sarcasm and resentment. It was more than two-and-a-half hours after the start of her shift, and she still hadn’t been in to look at our mother. The chart shows that through the rest of the night, the nurse allowed six hours to elapse between checks of our mother.

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